[ effect of a single dose of gabapentin on the rate of consumption of propofol and remifentanil during total intravenous anesthesia]

Gabapentin [structural analog of GABA], is an antiepileptic drug that its preoperative administration results in postoperative pain reduction. Considering the hypnotic effect of propofol, which is mediated by its attachment to GABAA, this hypothesis was propounded that administration of gabapentin can probably decrease the need for propofol and remifentanil during total intravenous anesthesia. Fifty patients scheduled for elective laparoscopic cholecystectomy, were assigned into two equal groups [n=25] in this randomized double blinded clinical trial. Study group received oral gabapentin [1200mg], and control group received placebo 3hrs before operation. Premedication and induction of anesthesia were the same in all patients. For the maintenance of anesthesia, oxygen and nitrous oxide [50%-50% mixture] and propofol and remifentanil infusion were used. The rate of propofol infusion was adjusted to maintain BIS in the range of 40- 60, and dose of remifentanil adjusted to maintain hemodynamic variables in the range of +/- 20% of baseline values. At the end of anesthesia the duration of anesthesia and the total amount of propofol and remifentanil used for every patient were recorded. The demographic parameters were similar in both groups [p>0.05]. Doses of propofol and remifentanil used for study group were significantly lower than doses used for control group [p<0.01]. The mean values of baseline systolic, diastolic, mean arterial, heart rates and BIS in the study group were lower than the corresponding values in the control group [p<0.05]. This study showed that a single dose of gabapentin before operation can decrease the need for propofol and remifentanil in total intravenous anesthesia during laparoscopic cholecystectomy

Postoperative respiratory distress in a patient with history of familial Mediterranean fever

Postoperative respiratory distress and pulmonary edema can be seen after a wide variety of serious clinical situations, or rare diseases such as familial Mediterranean fever [FMF]. FMF is a multisystemic disorder characterized by recurrent bouts of fever and pain due to inflammation of the peritoneum, synovia, or pleura. We report a case with history of FMF who developed postoperative respiratory distress after repairing the abdominal incisional hernia. Ten hours after administration of colchicine, the patient's symptoms were reduced. This rare disease should be included as a differential diagnosis for acute-onset respiratory distress in postoperative period

Intratracheal administration of lidocaine for sedation of patients under mechanical ventilation: a double-blind randomized clinical trial

Some patients with respiratory failure who are in need of mechanical ventilation require sedation to tolerate the inserted endotracheal tube [ETT] and other unpleasant stimuli. While a light sedation is satisfactory, deep sedation can interfere with the weaning process of patient from mechanical ventilator. Nevertheless, so far, the ideal regimen for sedatives and analgesics has not been found. We evaluate the effect of intratracheal administration of lidocaine for sedation of patients under mechanical ventilation. In a double-blind randomized clinical trial, 50 patients aged 33-65 years who had no obvious brain injury, in need of mechanical ventilation were enrolled into this study. They were randomized into two groups; the treatment group received 2.5 mL of 2% lidocaine, and the control group received 2.5 mL of normal saline via ETT each two hours for 12 h under sterile conditions. The baseline sedation was maintained with morphine, midazolam, or both, which were titrated to patient comfort and to maintain an optimum sedation score throughout the entire study. During 12 h of the study, the mean +/- SD total morphine and midazolam requirements were 7.13 +/- 0.96 and 4.65 +/- 1.15 mg, respectively, in the treatment group, and 11.08 +/- 0.77 and 6.37 +/- 1.17 mg, respectively, in the control group. There was a significant [P<0.05] reduction in the requirements for both drugs during the study in the treatment group as compared to the control group. Intratracheal administration of lidocaine significantly reduces sedative requirements in intubated patients during 12 h. In the short-term, no side effects or complications were observed

Evaluation of the effectiveness of lidocaine infusion in reduction of postoperative pain

Postoperative pain is an acute pain related to size and site of operation, patient's psychologic and physiological condition, degree of manipulation and damage of tissues. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Administration of opioids is one of the common techniques for postoperative pain management, but complications related to opioids leads to use of other methods for pain control. In this study we evaluated the effect of low dose lidocaine infusion for postoperative pain control. In this study, 30 patients were randomized in two study and control groups under similar conditions. In study group, administration of lidocaine 1% [1.5mg/kg followed by 1.5 mg/ kg /h infusion] was started 30 minutes before operation, and continued 1 hour after operation. In control group, normal saline [placebo] was used. After 24 hours, pain of patients and systemic analgesic consumption was assessed and analyzed. Results showed that infusion of low dose lidocaine does not reduce postoperative pain and amount of morphine consumption 24 hours after operation. Difference in results of this study and other similar investigations can result from difference in design and selected surgical procedures. Also, lack of medical and research equipments such as appropriate PCA [Patient Controlled Analgesia] and measurement of blood levels of lidocaine were limitations of this study